Cleveland Clinic Family Health Center new model of care

Focusing on quality care, safety, appropriate treatment

By BOBBY WARRENStaff WriterPublished: February 5, 2013 4:00AM

WOOSTER -- The Cleveland Clinic Family Health Center in Wooster is looking to add six patient care coordinators as it continues with the implementation of a pilot program geared toward value-based operations.

Dr. Jill Schaeffer, associate medical director of the Cleveland Clinic Wooster, is working with the Cleveland Clinic Medicine Institute on the patient-centered medical home model of care. It is targeted to work with patients who are Medicaid and Medicare eligible.

Areas of focus include quality of care, patient safety, appropriate treatment, patient satisfaction and access to care at the right time, Schaeffer said.

"There are many components we are doing already," Schaeffer said. "But, we are making some small changes."

"We want to follow these small groups of patients so we can help them navigate the health care system and help them in the long run," said Dr. Tony Tizzano, medical director for the Wooster Family Health Center. "We are looking at the quality of the care and not just is it good care. Can we prove it is good care and appropriate care."

The goal is to make sure the patients have what they need for successful outcomes, and it will require follow-up contacts, Tizzano said.

This is why the Clinic is recruiting six patient care coordinators. They will be registered nurse positions that will work with the patients in between physician visits and during transitions, whether moving from a hospital back home or a hospital to a nursing home, Schaeffer said. These coordinators will communicate with patients and assist them with their care, doctor visits, arranging transportation and addressing social needs. The new model will likely include some home visits, too, she added.

Another area of assistance is pre-visit planning. If a patient is dealing with diabetes, then the care coordinator will want to ensure lab work has been ordered and the results are back before the patient schedules an appointment to see a physician, Schaeffer said. This will help avoid delays in properly treating patients.

To demonstrate quality care is being provided, it is not only necessary to measure what is being done compared to the outcomes, but electronic medical records become an important component, Tizzano said.

The current model of health care is to pay for services provided, said Jim Madasz, administrator of the Cleveland Clinic Wooster. "As we move forward in the Affordable Care Act, that changes. We are moving into an area of being paid for outcomes. That is a totally different mentality."

There are a number of metrics involved with the program, including blood pressure rates, control of diabetes, immunization rates, colonoscopy rates and mammography rates.

These metrics help those who pay for services determine whether they are paying for quality care, Tizzano said. "We know that the federal government is a bigger piece of the payor group, and they are exerting more control."

The patient-centric focus of the new model is something the Cleveland Clinic has been doing, "But, we're doing it more now," Madasz said.

"We're trying to improve efficiencies and development collaborative relationships," Schaeffer said. "But, we're not quite sure what it will look like."

As the program continues to evolve, Schaeffer said she would like to see the Cleveland Clinic collaborate with mental health agencies in order to address some behavioral needs.

Reporter Bobby Warren can be reached at 330-287-1639 or bwarren@the-daily-record.com. He is @BobbyWarrenTDR on Twitter.

Want to leave your comments?

As an employee, I would like to address the Same Day Appointment issue. We know that there is an issue with the advertising of this as the ads do not state that the same day appointment may not be with your provider, or even here in Wooster. Unfortunately, this comes from the administration in Cleveland, not here in Wooster.
Also, the appointment center is a known issue that has numerous concerns. However, we were told that it's not going to go away. Us, as nurses are very frustrated with it as well, but we have to do what we have to do. I would like to express to everyone to let us know the issues/concerns that you have regarding any matter that comes up as we can direct you to the appropriate person. That way, hopefully something positive can come out of this.

February 5, 2013 6:18PM

2859,
Amen! I always speak with my doctor's nurse. It's the only way to keep from being routed all over N.E. Ohio.

February 5, 2013 11:34AM

While this all sounds good, I have found dealing with the Cleveland Clinic Wooster very frustrating when trying to schedule a same-day appointment. They book their internists so you can't get an appointment for weeks, and they route all same-day stuff to a nurse practitioner or Urgent Care. When I called the appointments number for a same day appointment, I was told I could get one -- if I was willing to drive to Rocky River. So I called my doctor direct, rather than go through the appointments number, and was at least able to see a nurse practitioner. Not my idea of the "continuity of care" that best serves the patient.